A Case of Gerstmann-like Syndrome Following Coronary Artery Bypass Grafting

Neuropsychological dysfunction after cardiac surgery may contribute to postoperative morbidity. We usually evaluate neuropsychological function using a revised version of Hasegawa's dementia scale (HDS-R) before and after cardiac surgery. HDS-R is a brief, easily-scored (maximum score 30 points) test of several cognitive functions. A 67-year-old man underwent coronary artery bypass grafting. His preoperative HDS-R score was 29. Surgery was completed uneventfully. Although he had no neurological abnormality postoperatively, HDS-R scores 1 day and 7 days after surgery were 17 and 19, respectively. His main intellectual impairment was acalculia. In addition to this, a left parietal infarction was newly detected in postoperative MRI. He was diagnosed as having Gerstmann-like syndrome (three other major symptoms, finger agnosia, right-left disorientation and agraphia were not found). Acalculia remained in an 8-month follow-up. Neuropsychological deficit is not a trivial affliction and may exert an adverse effect on the quality of life. The evaluation of neuropsychological function following cardiac surgery is important.